Pain, fatigue and sleep

Question 1

Most common circadian rhythm issue

Answer 1

Delayed sleep phase cycle

Question 2

Features of narcolepsy

Answer 2

Sudden sleep attacks (narcolepsy)
Excessive daytime sleepiness
Cataplexy
Sleep paralysis
Hypnogogic hallucinations

Question 3

CSF finding in narcolepsy

Answer 3

Low hypocretin-1

Question 4

Medications used for narcolepsy

Answer 4

Methylphenidate
Modafinil

Question 5

Percentage of men with obstructive sleep apnoea

Answer 5

4%

Question 6

Percentage of women with obstructive sleep apnoea

Answer 6

2.5%

Question 7

Stages of sleep where sleep walking occurs

Answer 7

3 and 4

Question 8

Time of the night where night terrors occurs

Answer 8

First third of the night

Question 9

Time of the night where REM sleep behavioural disorder occurs

Answer 9

Middle to last third

Question 10

First line treatment for REM sleep behavioural disorder

Answer 10

Clonazepam

Question 11

Features of restless leg syndrome

Answer 11

Akathisia, usually with parasthaesia
Motor restlessness
Symptoms worsen at rest
Symptoms worsen at night

Question 12

Predisposing factors for restless leg syndrome

Answer 12

IDA
Peripheral neuropathy
Sedative antihistamines
Antipsychotics
Caffeine
Antidepressants

Question 13

First licensed drug for restless leg syndrome

Answer 13

Ropinirole

Question 14

Disorder characterised by period episodes of repetitive and stereotyped limb movements during sleep

Answer 14

Periodic limb movement disorder

Question 15

Disorder characterised by grinding of the teeth during sleep or while awake

Answer 15

Sleep bruxism

Question 16

Type of insomnia usually associated with anxiety

Answer 16

Initial insomnia

Question 17

Type of insomnia usually associated with depression

Answer 17

Terminal insomnia/early morning wakening

Question 18

Prevalence of CFS in the UK

Answer 18

2.6%

Question 19

Prevalence of CFS in the UK once co morbid psychological diseases are ruled out

Answer 19

0.5%

Question 20

Male:female ratio of CFS

Answer 20

1:3

Question 21

Typical age of onset of CFS

Answer 21

29-35

Question 22

Typical duration of illness of CFS

Answer 22

3-9 years

Question 23

Features of CFS that predict a poor outcome

Answer 23

Claiming a disability related benefit
Low sense of self control
Strong focus on physical symptoms
Being passive with reduced activity
Membership of a self help group

Question 24

Percentage of people with CFS who are unable to work

Answer 24

33%

Question 25

Evidence based treatments for CFS

Answer 25

CBT Graded exercise therapy

Question 26

Percentage improvement rate in CFS after CBT treatment

Answer 26

70%

Question 27

Percentage improvement rate in CFS after graded exercise therapy treatment

Answer 27

55%

Question 28

Percentage of patients with CFS who have concurrent depression

Answer 28

23%

Question 29

Percentage of patients with CFS who have a lifetime history of depression

Answer 29

50-75%

Question 30

Efficacy of antidepressants in treating CFS

Answer 30

Not effective unless being added to ongoing CBT

Question 31

New term for pain disorder in DSM V

Answer 31

Somatic symptom and related disorders

Question 32

Percentage of depressed adult patients who report pain

Answer 32

43%

Question 33

Sleep disorder with a female predominance

Answer 33

Nightmares

Question 34

Length of time symptoms need to be present for a diagnosis of CFS

Answer 34

6 months

Question 35

Diagnostic symptoms of CFS

Answer 35

Brain fog Sore throat Tender cervical or axillary nodes Muscle pain Multipoint pain without joint swelling Headaches Unrefreshing sleep Post-exertional malaise lasting >24 hours

Question 36

Average length of time of symptoms of night terrors

Answer 36

5-10 minutes

Question 37

Muscle tone during night terrors

Answer 37

Increased

Question 38

Usual recall of events of night terrors

Answer 38

None

Question 39

ICD 11 diagnosis which has replaced 'somatoform disorders' diagnosis in ICD 10

Answer 39

Bodily distress disorder

Question 40

Mechanism of action of modafinil, used to treat narcolepsy

Answer 40

Increases synaptic dopamine which activates hypothalamic neurons which release orexin/hypocretin

Question 41

Elimination half life of modafinil

Answer 41

10-12 hours

Question 42

Most common side effect of modafinil

Answer 42

Headache

Question 43

Psychiatric condition associated with 'doctor shopping'

Answer 43

Somatisation disorder

Question 44

Most common psychiatric diagnosis in patients with CFS

Answer 44

Depression

Question 45

Percentage of patients with restless leg syndrome who experience periodic limb movements during sleep

Answer 45

80-90%

Question 46

Supportive criteria for restless leg syndrome

Answer 46

Periodic limb movements in sleep First degree relative with RLS Symptom improvement with dopaminergic medication

Question 47

Core criteria for restless leg syndrome

Answer 47

Urge to move the legs Rest worsens urge Moving improves urge Symptoms worse at evening or night Other disorders excluded

Question 48

Area of the brain where lesions are found in REM sleep disorder

Answer 48

Brainstem

Question 49

First line medication for restless leg syndrome

Answer 49

Dopamine agonists e.g. ropinirole Gabapentin Pregabalin

Question 50

Symptom with the highest sensitivity for obstructive sleep apnoea

Answer 50

Snoring

Question 51

Good prognostic factors in CFS

Answer 51

Not attributing symptoms to a physical cause Lower severity of initial symptoms Regular physical activity High sense of control Younger age